Provider Demographics
NPI:1255076493
Name:BINK, ANDREA B (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:B
Last Name:BINK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460306
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94146-0306
Mailing Address - Country:US
Mailing Address - Phone:628-282-0022
Mailing Address - Fax:
Practice Address - Street 1:6301 N SHERIDAN RD APT 23K
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-5701
Practice Address - Country:US
Practice Address - Phone:628-282-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33410103TC0700X
NY024935103TC0700X
IL071010755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical